bridges

Question 1

considerations for a bride on examination

Answer 1

1. periodontal health, should be sufficient bone support for abutment teeth to support the bridge + depending on:
   -crown:root ratio
   -furcation involvement
   -tooth location
   -patient-related factors
2. teeth that are opposing and adjacent are important to assess their position and angulation. overeruption, tilted teeth adjacent to saddle area will prevent construction of fixed fixed bridge if their long axes aren’t aligned, as prep to allow a mutual path of insertion with no relative undercut will be overly destructive of tooth tissue
3. amount of tooth tissue remaining: the extent to which an individual tooth has been previously restored will govern its restorability. caution with a post and core tooth as an abutment
4. unrestored or minimally restored teeth should have adhesively bonded bridges so more conservative prep design

Question 2

indications for the replacement of missing teeth

Answer 2

increase masticatory efficiency
improve speech + function
preserve oral environment by preventing unwanted tooth movements, e.g. drifting and overeruption
improve distribution of occlusal loads
space maintenance
restore aesthetics
prepare patient for complete dentures

Question 3

treatment planning for replacement of missing teeth

Answer 3

history: clarify patient aims and expected outcomes, enquire about previous denture history
mh: drugs may decrease salivary flow
sh: transport arrangements
clinical exam: ridge form, compressability of mucosa. assess tongue size, volume and viscosity of saliva
sensibility testing and PAs of abutments
mounted study models

Question 4

options for replacement of missing teeth

Answer 4

no replacement: shortened dental arch to second premolars acceptable
bridges: fixed-fixed, cantilever, RBBs
implants
implant supported prosthesis
removable partial denture
complete immediate dentures
complete dentures
orthodontic space closure

Question 5

advantages and disadvantages of different treatment options to replace missing teeth

Question 6

general and local factors to consider a fixed vs removable prosthesis

Answer 6

general:
pt motivation/condition
age
health
occupation
cost

local:
OH and periodontal health
number of missing teeth
position of missing teeth
occlusion
condition of potential abutments
length of span
degree of resorption

Question 7

types of bridges

Answer 7

fixed-fixed conventional
fixed-movable
cantilever
RBB

Question 8

bridge: indications

Answer 8

 More acceptable to pt.
 Directs forces axially.
 Doesn’t cover gingival
margin.
 Public
speaker/performer?
 Restoring occlusion.
 Periodontal splinting.
 Ortho retention.

Question 9

bridge: contraindications

Answer 9

 Destructive of tooth
tissue.
abutment doesn’t have enough tooth tissue
 Good OH required.
 ?longevity of bridge.
 Periodontal implications
if sub-gingival margins.
 Cost.
demotivated pt
Requires no active
pulpal/periradicular/periodontal disease.

Question 10

fixed-fixed conventional bridge: advantages and disadvantages